Page 9 - Microsoft Word - E- Version Orientation Handbook- Rev-6

Capped Rental and Inexpensive or Routinely Purchased Items Notification for Services on or after January 1,
2006
I received instructions and understand that Medicare defines the Equipment
_____________________________________that I received as being either a capped rental or an inexpensive or
routinely purchased item.

FOR CAPPED RENTAL ITEMS
Medicare will pay a monthly rental fee for a period not to exceed 13 months after which ownership of the

equipment is transferred to the Medicare beneficiary.
Examples of this type of equipment include:
Hospital beds, wheelchairs, alternating pressure pads, air-fluidized beds, nebulizer, suction pumps, and
continuous airway pressure (CPAP) devices, Bi- Level devices, patient lifts and trapeze bars.
Medicare will pay a monthly rental fee for a period not to exceed 36 months after which ownership of the
equipment is transferred to the Medicare beneficiary. An example of this type of equipment includes:
Oxygen concentrator.
After ownership of the equipment is transferred to the Medicare beneficiary, it is the beneficiary’s
responsibility to arrange for any required equipment service or repair.

FOR INEXPENSIVE OR ROUTINELY PURCHASED ITEMS
Equipment in this category can be purchased or rented; however, the total amount paid for monthly rentals
cannot exceed the fee schedule purchase amount.
Examples of this type of equipment include:
Canes, walkers, crutches, commode chairs, low pressure and positioning equalization pads, home blood
glucose monitors, seat lift mechanisms, pneumatic compressors (lymphedema pumps), bed side rails and
traction equipment.

I select the: Purchase Option ____ Rental Option ____

______________________________ __________
Beneficiary Signature Date

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